Contrast ultrasound in cardiovascular ischemic disease: shifting to theragnostic clinical trials

• Published in: JACC. Cardiovascular imaging 2021-10, Vol.15 (2), p.345-360
• Main Authors: El Kadi, Soufiane, Porter, Thomas R., Verouden, Niels J.W., van Rossum, Albert C., Kamp, Otto
• Format: Article
• Language: English
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2021.07.028

Contrast ultrasound has a variety of applications in cardiovascular medicine, both in diagnosing cardiovascular disease as well as providing prognostic information. Visualization of intravascular contrast microbubbles is based on acoustic cavitation; the characteristic oscillation that results in changes in the reflected ultrasound waves. At high power, this acoustic response generates sufficient shear that is capable of enhancing endothelium-dependent perfusion in atherothrombotic cardiovascular disease (sonoperfusion). The oscillation and collapse of microbubbles in response to ultrasound also induces microstreaming and jetting that can fragment thrombus (sonothrombolysis). Several pre-clinical studies have focused on identifying optimal diagnostic ultrasound settings and treatment regimens. Clinical trials have been performed in acute myocardial infarction, stroke and peripheral arterial disease often with improved outcome. In the forthcoming years, results of ongoing clinical trials along with innovation and improvements in sonothrombolysis and sonoperfusion will determine whether this theragnostic technique will settle as a valuable addition to reperfusion therapy.